To register, kindly complete one form per delegate. DELEGATE INFORMATION *Title: Select Dr Prof Mr Mrs Ms Miss *Last Name: *First Name:(for badge) Middle Name: Nationality: Gender: Select Male Female Other Prefer not to disclose MP Number: Do you agree that your name and email address can be given to sponsors of the congress: Yes / No *Organisation/Institute/Trust: *Position: This is my:(please select) Private / Institution Address: City: State/Province: ZIP/Post Code: Country: Select Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, Democratic Republic Cook Islands Costa Rica Côte d'Ivoire (Ivory Coast) Croatia (Hrvatska) Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea (north) Korea (south) Kosovo Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territories Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States of America Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands (British) Virgin Islands (US) Wallis and Futuna Islands Western Sahara Yemen Zaire Zambia Zimbabwe Work/Business Telephone Number: (Country code/city code/number) Fax: (Country code/city code/number) *E-Mail: *Verify E-Mail: Mobile/Cell Number: Special Dietary Requests: All meals provided are Halaal. Kosher meals can be arranged at an extra cost (price on application). Vegetarian: Yes / No / Other If other, specify: Other Requests Other Special Requests:(Please specify any access needs you have e.g. wheelchair user, mobility difficulties, hearing impaired etc.) *Compulsory fields. REGISTRATION FEES: CTG WORKSHOP Registration Fees - South African Rand (ZAR) Only (includes VAT) Registration Category Cost(Per day) No. ofPeople Amount(ZAR) Consultants Registration 750 0 1 2 3 4 5 6 7 8 9 10 Registrars, Medical Officers & Nursing Staff Registration 550 0 1 2 3 4 5 6 7 8 9 10 Please indicate the date you would like to attend by ticking the box applicable: Monday, 11 November 2019 Friday, 15 November 2019 Monday, 18 November 2019 Wednesday, 20 November 2019 Tuesday, 26 November 2019 FULLY BOOKED TOTAL: Registration Fees - CTG Workshop Registration fees Include: Attendance at the workshop on the specific day your register for, tea breaks, lunch, a name tag and a printed programme. TOTAL AMOUNT PAYABLE GRAND TOTAL: Registration Fees - CTG Workshop PAYMENT DETAILS Please select your payment option below. Option 1Bank Transfer You must specify your full name and UCT CTG Workshop on your bank transfer. Forward to: Account Name:Turners Conferences & Conventions Pty Ltd - UCT CTG Workshop Bank:First National Bank Account No.:62766694634 Branch: Branch Code:250655 Swift No.:FIRNAJJ (Please fax a copy of your transfer to Turners Conferences +27 31 368 6623) Final date for Bank Transfer payments will be the 2 July 2019. All fees associated with Forex payments are for your own account. Please instruct your bank accordingly when processing payment. Option 2Credit Card When opting to process payment by credit card, further instructions will be emailed advising on how to process payment via the online 3D PayGate Portal. A unique reference number will be issued to you. Please complete this booking form and submit it to the Turners Conferences: Turners Conferences and Conventions (Pty) Ltd PO Box 1935, Durban, 4000 South Africa Telephone: +27 31 368 8000 Fax: +27 31 368 6623 Email: leannea@turnersconferences.co.za All transactions are conducted in terms of Turners Conferences standard conditions of trading. They are published on the Turners Conferences website & available on application. Without the complete documents, we are unable to process your booking. Your booking will only be confirmed once payment has been received. All published prices are subject to change without prior notice. This may be due to currency regulations and/or changes in duties or taxes. Type this number into the box alongside:
To register, kindly complete one form per delegate.
Registration Fees - South African Rand (ZAR) Only (includes VAT)
Registration fees Include: Attendance at the workshop on the specific day your register for, tea breaks, lunch, a name tag and a printed programme.
Please select your payment option below.
Please complete this booking form and submit it to the Turners Conferences:
All transactions are conducted in terms of Turners Conferences standard conditions of trading. They are published on the Turners Conferences website & available on application. Without the complete documents, we are unable to process your booking.
Your booking will only be confirmed once payment has been received.
All published prices are subject to change without prior notice. This may be due to currency regulations and/or changes in duties or taxes.